As we age, the effects of gravity and loss of skin elasticity cause static wrinkles (present even when the face is at rest) to appear. Volume changes also have an aging effect – both through loss of volume (in the upper cheek, under eye area) and gaining of volume (in the jowl and neck area). Facelift surgery traditionally addressed only the wrinkles, however a modern approach recognises that addressing the volume changes is equally, if not more important in achieving a revitalised appearance. People age at different rates, and a variety of factors such as sun exposure, smoking history, genetics, and weight fluctuations will have a significant impact on the age at which a face lift becomes appropriate.
A number of different facelift procedures exist. The most appropriate procedure depends on the predominant area of concern. The most common procedures are a lower face/ neck lift, which addressed the jawline and neck area, as well as lifting and tightening the muscle layer (SMAS) layer of the face. The incision for this procedure runs from the temple hairline, under the earlobe, behind the ear, and into the posterior hairline. In patients in whom there is less laxity and the neck is not such a major concern, a more limited incision, which does not extend under and behind the ear may be employed.
It is important to bear in mind that facelift surgery is intended to address the lower face only, and will not impact on the appearance of the eye or forehead area. These areas can be treated, for example with upper or lower eyelid surgery, or a brow lift, under the same anaesthetic. Increasingly, lipofilling (fat injections) are employed to compliment the results of the lifting, by restoring youthful volume to the cheek area. Delicate liposuction to the jaw or neck area may be used as part of the procedure.
Type of anaesthetic
Length of surgery
Nights in hospital
From hair-bearing area of temple, in front of ear ± curving under earlobe, behind ear, and into hairline, ± under the chin
2-3 weeks off work
4 weeks gentle exercise
6 weeks strenuous exercise
1 week (dressing clinic)
My guiding principles of balance, proportion, and natural appearance apply to facelift surgery, as they do to every other cosmetic procedure I perform. My aim is to leave you looking revitalised and fresh, but never “done” or over-stretched. I believe that there are three key issues that need to be addressed when assessing a face for a rejuvenation procedure. They are the quality and elasticity of the skin, identification of areas of excess and deficient volume, and the effects of gravity. I believe the best results are achieved when all three areas are balanced, and my role is to advise to you as the the areas of priority to best achieve the results you seek. As with any cosmetic surgery operation I perform, I recommend that we meet twice prior to proceeding with surgery, in order that the treatment plan and goals are clear to us both, and that you will have had a chance to think things over and ask any questions that come to mind.
There are a few steps that you can take prior to surgery to enhance your result. If you are overweight and intend to lose weight, it is best to do so before the surgery. This will allow me to remove more skin, and will avoid a recurrence of loose skin which could occur if you were to lose the weight shortly after surgery. I recommend that you avoid aspirin or other NSAIDs (non-steroidal anti-inflammatories such as ibuprofen or diclofenac) for two weeks before surgery, as they increase your risk of bruising and bleeding. Certain other medications, including over-the-counter medications may also have this effect, so it is important that you let me know at the time of your consultation if you are taking anything. Facelift surgery is one of those procedures where smoking can have a dramatic adverse effect on the outcome. It is vital that you let me know if you are a smoker, in order that I can plan a safe procedure for you. I strongly recommend that you stop taking nicotine in all its forms (including e-cigarattes, pathces, gum, etc.) a minimum of two weeks before surgery, and for at least a week afterwards. On a practical note, if you colour your hair, I advise you to have it done shortly before surgery, as I advise against exposing your fresh scars to the chemicals used in the first few weeks following your operation.
The procedure is usually carried out under general anaesthetic. I advise a stay of at least one night following surgery, although many patients, depending on where they live or their home circumstances, may prefer to stay a second night. The incisions as described above will be made, the muscle layer of the face lifted and tightened, and excess skin removed. Immediately following the surgery, you will have a bulky dressing around your head, and a small drain on either side. The dressing will be reduced in size and the drains removed the following day. I use removable stitches to the skin, and skin clips in the hair-bearing areas (to reduce the risk of injury to the hair follicles). These are all removed at approximately one week following surgery.
Consequences and limitations
Some bruising of the face is normal after surgery. With gravity and, this usually descends into the neck. There is substantial variation between patients in terms of the amount of bruising they experience, and there may be quite a difference between the two sides in the same patient. This bruising will of course settle with time, and camouflage make-up may be useful at this time. Discomfort should not be more than mild, and paracetemol is usually adequate to control this. Some swelling is normal after surgery, and is generally worse in the mornings. I recommend sleeping in as close to a seated position as possible, in order to minimise this.
When the skin is cut in a surgical incision, the tiny nerve endings in the area are also cut. This will give rise to some numbness of the skin of the cheeks and ears, which is normal, and should settle with time. There is, however, a risk of permanent numbness, which may be quite noticable initially, but tends to bother people less with time. There is also a risk of injury to the nerve that moves the face and mouth. This risk is very low, but if it does occur, it can be quite distressing to patients. Usually the resultant muscle weakness will improve with time, and botulinum toxin injections can help minimise the impact on facial symmetry during the course of the recovery.